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DALTON VENDEN

Athletic Trainer >> Specialist/Technologist >> Respiratory, Developmental, Rehabilitative and Restorative Service Providers

Registrant NPI Number: 1609261841

Individual Registrant:
 DALTON  VENDEN 
Gender: M
Sole Proprietor

Location and contact information for practice:
448 W MADISON ST  WATERLOO, WI 53594-1325 US
Tel: 920-988-8312  Fax: --

Contact information for business:
448 W MADISON ST  WATERLOO, WI 53594-1325 US
Tel: --  Fax: --

Registration Information:
NPI: 1609261841
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service Providers
Specialist/Technologist
Athletic Trainer
MI2601001252

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
BOARD OF CERTIFICATION-ATHLETIC TRAINER CERTIFICATION NUMBER200001323601




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